MEDICARE: CALEB CLARK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7812	LA
2	122300000X	Dentist	D.007465-C1	AL

General Provider Information

NPI Number	:	1164312757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB CLARK DMD

Provider Business Mailing Address
First Line	:	1712 RIDGEWOOD PL
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-1630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 W NAPOLEON AVE
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-2266
Country	:	US
Telephone Number	:	504-455-2182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	06/04/2026

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Directions to “ CALEB CLARK DMD” Practice Location

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